interRAI Assessment Research Articles

Can Avatar Robots Assist Older People and Care Professionals? Evaluation of an Intervention Study in Eight Nursing Homes in Tokyo

Abstract Background Securing human resources to meet increasing demand for older people's care is challenging, particularly in Japan, where the pace of ageing is accelerating. Central and local government have been seeking partial solutions in assistive technologies such as robotics. Against such a background, the study was conducted in 8 nursing care homes in Tokyo, where avatar robots were tested to examine whether and how these robot interventions can affect the daily life of older people and care professionals. Methods Four different types of avatar robot (ORIHIME, NEWME, Piyokame and BOCCO) were introduced to and used in eight nursing care facilities, in order to create conversational opportunities over 12 weeks. Before–after studies were conducted, and a variety of data was collected (interpersonal communication, self-care and depressive tendencies using the International Classification of Functioning, Disability and Health (ICF) and InterRAI assessments). System usability scores (SUS) were collected from care professionals, who also performed a time-on-task analysis. Results Study participants who consented to taking part were 136 older adults (88.4±6.6 years old, 18 men and 118 women) and 63 care professionals. Participants with a high degree of dependency accounted for 31 percent. In total, 136 avatar robots were used. There was an overall, yet marginal, improvement for older people. While the SUS scores were poor, the majority (90 percent) responded that such devices would prove useful in the future. The time-on-task analysis indicates that more time can be secured for ‘person-to-person’ care. Conclusion Positive impacts of avatar robots (to increase the level of social interaction and communication) were observed. However, the results are inconclusive, and more needs to be done with regard to technology skills, competence enhancement and data collection methods for this type of research. The study was funded in part by the Tokyo Metropolitan Government.

Predictors of Pain and Mood Disturbances Among Older People in Custody Using an interRAI Assessment.

The population of people in federal custody in Canada is aging. Those in custody report experiencing poorer health and high rates of chronic health conditions. Two health concerns that are disproportionately higher among those in custody are mood disorders and pain. This cross-sectional study examined health indicators associated with pain and depressive symptoms among older people (50 years and above) from multiple facilities and security levels in federal custody in Canada. Participants were assessed using the interRAI Emergency Department Contact Assessment, which captures key health indicators. Chi square and logistic regression analyses were conducted to describe the population and identify health indicators associated with mood- and pain-related outcomes, respectively. Of the 1,422 participants in this study, the majority (55%) experienced pain and at least 1 out of 5 experienced depressive symptoms. Health indicators associated with depressive symptoms and/or pain were functional measures, including mobility, managing medication(s), and dyspnea. Depressive symptoms and pain are highly prevalent among older adults in federal custody. The relationship between functional health, depressive symptoms, and pain highlights the importance of interprofessional health care and biopsychosocial intervention(s).

Effects of changing criteria on improving interRAI assessment for elder abuse: analysis of a national dataset from Aotearoa New Zealand

ObjectivesGlobally, one in six older adults in the community will be a victim of abuse (elder abuse; EA). Despite these horrific statistics, EA remains largely undetected and under-reported. Available screening...

Information technology-supported integrated health service for older adults in long-term care settings

BackgroundTo examine the effectiveness and safety of a data sharing and comprehensive management platform for institutionalized older patients.MethodsWe applied information technology-supported integrated health service platform to patients who live at long-term care hospitals (LTCHs) and nursing homes (NHs) with cluster randomized controlled study. We enrolled 555 patients aged 65 or older (461 from 7 LTCHs, 94 from 5 NHs). For the intervention group, a tablet-based platform comprising comprehensive geriatric assessment, disease management, potentially inappropriate medication (PIM) management, rehabilitation program, and screening for adverse events and warning alarms were provided for physicians or nurses. The control group was managed with usual care. Co-primary outcomes were (1) control rate of hypertension and diabetes, (2) medication adjustment (PIM prescription rate, proportion of polypharmacy), and (3) combination of potential quality-of-care problems (composite quality indicator) from the interRAI assessment system which assessed after 3-month of intervention.ResultsWe screened 1119 patients and included 555 patients (control; 289, intervention; 266) for analysis. Patients allocated to the intervention group had better cognitive function and took less medications and PIMs at baseline. The diabetes control rate (OR = 2.61, 95% CI 1.37–4.99, p = 0.0035), discontinuation of PIM (OR = 4.65, 95% CI 2.41–8.97, p < 0.0001), reduction of medication in patients with polypharmacy (OR = 1.98, 95% CI 1.24–3.16, p = 0.0042), and number of PIMs use (ꞵ = − 0.27, p < 0.0001) improved significantly in the intervention group. There was no significant difference in hypertension control rate (OR = 0.54, 95% CI 0.20–1.43, p = 0.2129), proportion of polypharmacy (OR = 1.40, 95% CI 0.75–2.60, p = 0.2863), and improvement of composite quality indicators (ꞵ = 0.03, p = 0.2094). For secondary outcomes, cognitive and motor function, quality of life, and unplanned hospitalization were not different significantly between groups.ConclusionsThe information technology-supported integrated health service effectively reduced PIM use and controlled diabetes among older patients in LTCH or NH without functional decline or increase of healthcare utilization.Trial registrationClinical Research Information Service, KCT0004360. Registered on 21 October 2019.

Using interRAI Assessment for Research: Developing a National Research Agenda in Aotearoa New Zealand

interRAI provides a suite of standardized, validated instruments used to assess health and psychosocial well-being, and to inform person-centered care planning. Data obtained from these standardized tools can also be used at a population level for research and to inform policy, and interRAI is currently used in more than 40 countries globally. We present a brief overview of the use of interRAI internationally within research and policy settings, and then introduce how interRAI is used within the universal public health system in Aotearoa New Zealand (NZ), including considerations relating to Māori, the Indigenous people of NZ. In NZ, improvement in interRAI data utilization for research purposes was called for from aged care, health providers, and researchers, to better use these data for quality improvement and health advancement for New Zealanders. A national research network has been established, providing a medium for researchers to form relationships and collaborate on interRAI research with a goal of translating routinely collected interRAI data to improve clinical care, patient experience, service development, and quality improvement. In 2023, the network members met (hybrid: in-person and online) and identified research priorities. These were collated and developed into a national interRAI research agenda by the NZ interRAI Research Network Working Group. Research priorities included reviewing the interRAI assessment processes, improving methods for data linkage to national data sets, exploring how Indigenous Data Sovereignty can be upheld, as well as a variety of clinically focused research topics. Implications for Practice, Policy, and Research: This appears to be the first time national interRAI research priorities have been formally identified. Priorities identified have the potential to inform quality and clinical improvement activities and are likely of international relevance. The methodology described to cocreate the research priorities will also be of wider significance for those looking to do so in other countries.

Prevalence, country-specific prescribing patterns and determinants of benzodiazepine use in community-residing older adults in 7 European countries

BackgroundThe use of benzodiazepines (BZDs) in older population is often accompanied by drug-related complications. Inappropriate BZD use significantly alters older adults’ clinical and functional status. This study compares the prevalence, prescribing patterns and factors associated with BZD use in community-dwelling older patients in 7 European countries.MethodsInternational, cross-sectional study was conducted in community-dwelling older adults (65 +) in the Czech Republic, Serbia, Estonia, Bulgaria, Croatia, Turkey, and Spain between Feb2019 and Mar2020. Structured and standardized questionnaire based on interRAI assessment scales was applied. Logistic regression was used to evaluate factors associated with BZD use.ResultsOut of 2,865 older patients (mean age 73.2 years ± 6.8, 61.2% women) 14.9% were BZD users. The highest prevalence of BZD use was identified in Croatia (35.5%), Spain (33.5%) and Serbia (31.3%). The most frequently prescribed BZDs were diazepam (27.9% of 426 BZD users), alprazolam (23.7%), bromazepam (22.8%) and lorazepam (16.7%). Independent factors associated with BZD use were female gender (OR 1.58, 95%CI 1.19–2.10), hyperpolypharmacy (OR 1.97, 95%CI 1.22–3.16), anxiety (OR 4.26, 95%CI 2.86–6.38), sleeping problems (OR 4.47, 95%CI 3.38–5.92), depression (OR 1.95, 95%CI 1.29–2.95), repetitive anxious complaints (OR 1.77, 95%CI 1.29–2.42), problems with syncope (OR 1.78, 95%CI 1.03–3.06), and loss of appetite (OR 0.60, 95%CI 0.38–0.94). In comparison to Croatia, residing in other countries was associated with lower odds of BZD use (ORs varied from 0.49 (95%CI 0.32–0.75) in Spain to 0.01 (95%CI 0.00–0.03) in Turkey), excluding Serbia (OR 1.11, 95%CI 0.79–1.56).ConclusionsDespite well-known negative effects, BZDs are still frequently prescribed in older outpatient population in European countries. Principles of safer geriatric prescribing and effective deprescribing strategies should be individually applied in older BZD users.

Functional recovery in older adults with schizophrenia: A national interRAI study.

The concept of recovery for people with schizophrenia (PwS) is still a matter of debate. Growing numbers of PwS living to older age calls for examination of their disease trajectories with a focus on recovery. To compare two groups of PwS (good wellbeing; poor wellbeing) on several psychosocial variables associated with social wellbeing to identify interventions that support functional recovery. Data was drawn from participants from across New Zealand (NZ), who had received a formal diagnosis of Schizophrenia; were living independently in the community, and who had undergone their first International Resident Assessment Instrument (interRAI) assessment from 2012 to 2022. We compared two groups of PwS (good social wellbeing; poor social wellbeing) examining associations with demographic and psychosocial variables. We compared interRAI assessments for: 'poor psychosocial wellbeing' (n = 1,378; 67%; 56% female; 70.5% 65 years and over; 36.1% never married); and 'good psychosocial wellbeing' (n = 693; 33%; 61.1% female; 78.1% 65 years and over; 29.8% never married; n = 549 did not have sufficient social wellbeing data to be included). We found significant associations between social wellbeing and depression, disruptive behaviour, decision making, self-expression, understanding verbal information, activity level, self-reported health and medication adherence. Logistical regression showed depression (β = .84, p < .001, Wald = 51.01, Exp(B) = 2.31) and mild disruptive behaviour (β = .63, p = .002, Wald = 9.26, Exp(B) = 0.53) were the only predictors of poor social wellbeing. Those who reported some degree of depressive symptoms were 2.31 (CI [1.84, 2.91]) more likely to be in the poor social wellbeing group. A significant minority (33.5%) of older PwS enjoy positive social wellbeing. Several psychosocial variables are associated with wellbeing. By addressing the comorbidity of depressive symptoms, we may be able to improve wellbeing for older PwS.

Integrated institutional care based on comprehensive assessment – a case study of Yanda Long-term Care Centre in China

Introduction: Long-term elderly care institutions in China usually solely provide care for daily living to the residents. In response to the multiple needs of the elderly and the policies of integrating health and care by the government, some elderly care institutions started exploring new care models.Yanda Long-term Care Centre is a private institution with more than 5000 beds participating in the interRAI initiative in China. Partnering with a built-in community health care center, it explored integrated institutional care based on interRAI assessment.&#x0D; Practice change implemented: The Centre has established a service model of ""integrated multidisciplinary care based on comprehensive assessment"" to provide integrated health and social care for the elderly. The main concept of the model is to provide comprehensive and effective care through care management and multi-professional teamwork. This care model started its official operation in 2010 and the development is ongoing.&#x0D; Targeted population and stakeholders:The targeted population is all residents in the center especially those with disability or other chronic conditions. Key stakeholders include the management team of the facility, the case managers, the multi-disciplinary care team, the interRAI company in China and the residents’ families. &#x0D; Highlights&#x0D; &#x0D; Yanda Long-term Care Centre adopted a three-tier assessment model. A basic ADL assessment was conducted as initial screening, with disabled residents entering into the next comprehensive assessment which used Long Term Care Facility Assessment Scale (InterRAI-LTCF) as the tool. Specialist assessment scales measuring functional, cognitive, nutritional, spiritual and other dimensions will be employed for specific conditions, such as mini nutritional assessment (MNA), Braden scale for predicting pressure score risk etc.&#x0D; The case managers are responsible for assessing the needs of the elderly and the quality of long-term care services, developing and guiding the implementation of integrated long-term care plans, integrating care resources.&#x0D; Multi-disciplinary care team supported by the built-in community health center，include physician, nurse, therapist, nutritionist, pharmacist, physical and occupational therapist , social worker and so on. They provide comprehensive services, including medical, nursing and rehabilitation services, health management upon needed.&#x0D; &#x0D; &#x0D; Comments on sustainability and transfer-ability: The service model could be sustainable if the current management team of the facility remains stable. The service procedures, assessment methods, case management and multidisciplinary team formation based on the built-in health care center all provide valuable experiences for other elderly care facilities to learn and practice in China.&#x0D; Discussion: Despite progress made, there are still some barriers, including the lack of training systems for professional assessors, underdevelopment of the insurance system for integrated long-term care services.&#x0D; Conclusion: The model develops individualised service plans based on comprehensive assessment and establishes a case management system, providing integrated interventions and services to high-needs residents. It reduces the incidence of risk, improves residents’ quality of life and acquires high satisfaction from both residents and their families. Attention should be given to a more standardised implementation pathway for comprehensive assessment, cultivation of professional talents and further development of financing and payment systems for integrated long-term care services.&#x0D; &#x0D;

Developing the Patient Falls Risk Report: A mixed-methods study on sharing falls-related clinical information from home care with primary care providers

Background: Only 24% of Canadian primary care providers communicate with home care providers about the needs and services of patients. This service gap puts vulnerable people at risk of adverse events. One tool that may enhance communication between home care and primary care is the interRAI home care (interRAI-HC), a mandated comprehensive geriatric assessment in home care. The focus of this study was on development of a one-page document for sharing falls-related clinical information from the interRAI-HC with primary care providers (i.e., the Patient Falls Risk Report).&#x0D; Target audience: Primary care providers who feel siloed from the rest of the health care system.&#x0D; About the intervention: The Patient Falls Risk Report is a structured, one-page, faxable form that contains falls-related patient information derived from interRAI-HC assessments. The report is evidence-based and includes personalized information on future falls risk, balance, cognition, pain, foot problems, medications, and physical activity levels, as well as recommendations for falls prevention in older persons.&#x0D; Stakeholder engagement and other research methods: This mixed-methods intervention development study began with one-on-one stakeholder engagement via semi-structured interviews with primary care providers. We first explored their views on falls-related information sharing. Then, we tested a prototype of the Patient Falls Risk Report for usability and utility, thematically analyzing the findings to iteratively to develop the tool. The report was then evaluated again with voluntary self-report surveys based on the System Usability Scale.&#x0D; Results: A sample of 9 interview participants co-developed the Patient Falls Risk Report to improve its clarity and level of detail. All participants stated that they would use the report in their practices and most believed that it could support care provision due to its inclusion of relevant, actionable information. In the end, a survey sample of 27 participants determined that the report was highly usable, with an overall usability score of 83.4 (95% CI = 78.7, 88.2). However, the need for improved shared care planning and community responsibility was also emphasized.&#x0D; &#x0D; Impact: This study demonstrates that information collected from existing clinical assessments can be shared with primary care providers in a useful manner. It also highlights criteria to inform the design of future information-sharing interventions, especially those harnessing interRAI assessments.&#x0D; Key Learning: Primary care providers need tailored and consistent streams of communication with other health care providers so that collaboration and integration can become a reality. &#x0D; Next Steps: We are at a turning point in health care, where the functionality of health information systems is improving, and fax is becoming increasingly obsolete. Based on the recently published results of this study [1], we are currently collaborating with government and eHealth organizations on an implementation plan for interRAI information sharing with patients and caregivers in Ontario, Canada. &#x0D; 1. Nova AA, Heckman G, Giangregorio LM, Alarakhia M. Developing the Patient Falls Risk Report: A Mixed-Methods Study on Sharing Falls-Related Clinical Information from Home Care with Primary Care Providers. Canadian Journal on Aging / La Revue canadienne du vieillissement. 2022;1–14.&#x0D; &#x0D; &#x0D;

Comprehensive Standardized Assessment for Information Continuity: What Does the Workforce Need

Introduction: Older adults living with frailty and multimorbidity interact with multiple care providers across different health settings increasing the risk for fragmented care and information discontinuity. Information discontinuity results in workforce inefficiencies and adverse health events, including duplication of assessment and diagnostics, medication errors and increased health service use. Standardized assessments potentiate integrated care by communicating consistent measures of health information between health care sectors and providers. InterRAI assessments facilitate integration through promoting a common language and aligning successive assessments across the care continuum.&#x0D; Description: We used a pragmatic case example of a theoretical medically-complex older adult to illustrate effective use of interRAI standardized assessments throughout the health care journey. The interRAI suite of instruments spans across the age continuum, from pediatrics to geriatrics, and is designed to be used across diverse care settings, including community services, primary care, home care, long-term care, acute care, inpatient and community mental health, and palliative services. The case example represents one patient’s assessment findings, derived from standardized assessment instruments, such as the contact assessment, home care assessment and long-term care facility assessment. Automated and embedded risk algorithms are generated as outputs from the assessment, acting as decision support tools to inform care planning for clinical, functional, and social support needs. Process schematics depict potential workflows, where instruments can guide care strategies and facilitate the flow of information between the care team members.&#x0D; Discussion: Integrating elements such as using a common language, standardized assessment items, and embedded decision support algorithms, can support effective communication and collaboration in the care of older adults between clinical settings. Risk algorithms and scales support real-time identification of care issues, with standardized assessment items allowing for changes in health status to be easily recognized. Operationalizing a suite of standardized assessment instruments across the health system offers advantages for the individual including improved continuity of care, as well as for organizations and the system through use of a consistent measurement of health metrics between health providers and sectors, and evaluating health system performance. Successful adoption of comprehensive assessment tools to support integration requires training, stakeholder engagement and time to embed work and care processes into practice.&#x0D; Conclusion: Standardized language and algorithms used in interRAI comprehensive assessments can increase capacity for integration and continuity of care across the full spectrum of health sectors and settings. Findings from this pragmatic case example demonstrate real-world application and utility of standardized assessments to support an integrated workforce.

Perceptions of care-dependent older people in nursing homes about their oral health and oral care

Background: Oral health is associated with general health but often remains neglected in residential care settings. Integration of oral care into general care is necessary, but literature shows that appropriate oral care is hampered by multiple barriers. Among older people, attitudes towards oral health and oral care are poor, as they are often unaware of the importance of oral health. The lack of ability to perform their own oral care, due to ageing, is also a perceived barrier. This study is part of research on the implementation of the new Oral Health Section (OHS) in the interRAI assessment of general care needs of nursing home residents. The aim of the study is to identify older people’s experiences with their own oral health, with the oral care performed, their perception of the importance of oral care, as well as their meaning about the assessment of their oral health using. &#x0D; Setting and participants: Care-dependent older people living in 3 Flemish nursing homes. &#x0D; Methods: In-depth interviews were performed and the Oral Health-Related Quality of Life 14 (OHIP-14) instrument was completed. This validated instrument measures the degree of self-rated oral health and satisfaction with the oral health status. The OHS was also filled out, which assesses whether they need assistance with daily oral hygiene care (Oral Hygiene CAP) and whether they need to be referred to a dentist (Dentist CAP). Interviews were coded, validated and discussed by 2 researchers and analysed in the software Nvivo1.7.&#x0D; Results: A total of 22 care-dependent older people were interviewed. The mean age of the sample was 84.5 (± 8.2 SD) and 63.6% were female. A total of 11 participants (50%) had no teeth but wore dentures; the others still had their natural teeth. The mean score of the OHIP-14 was 3.9 (range 0-56), indicating good scores for oral health-related quality of life. All older people who still had their natural teeth found it important to keep them in the future. Most older people were satisfied with their own oral health (81.8%), although, according to the results of the CAPs, 86.4% of them scored poorly on the assessment of oral hygiene and 68.2% needed immediate referral to a dentist. This shows that older people tend to overestimate their own oral health and are often satisfied, despite having several oral health problems.&#x0D; Conclusions/implications: The study provided information about the perceptions and experiences of older people regarding their oral health and oral care. Learning about their experiences and perceptions can help to identify their wishes and needs, making it possible to improve daily oral care and proactively develop strategies to provide effective dental care for the future older population. Policy makers can use these results to foster the integration of oral care guidelines into care protocols within nursing homes, as well as support collaboration with dentists and dental hygienists within care facilities.

Comparing approaches to determining poor oral health among older adults in a national survey.

To compare the clinical validity of the three approaches in residential care facility residents. In NZ residential care facilities, the interRAI assessment tool is used by trained registered nurses for assessing oral status when new residents are admitted, but its validity has been questioned. Although Locker's global oral health item has been used to measure oral health in surveys and health services research, it is not routinely used in care facilities, yet its clinical validity has been demonstrated in population-based samples. Self-perceived oral health need may also be useful. Using a secondary analysis of clinical and self-reported data from a national survey of nursing home residents (the 2012 New Zealand Older People's Oral Health Survey, or OPOHS), we compared the validity of Locker's item, the interRAI tool and self-reported treatment need for identifying three key clinical indicators of poor oral health among dentate older adults; those were coronal caries (3+ teeth affected), root caries (1+ teeth affected) and xerostomia. Analyses were conducted using STATA, and survey weighting was used to obtain estimates for a source population of 25-843 individuals. The prevalence of 3+ teeth with coronal caries was 28.7% (23.9, 34.0), the prevalence of 1+ teeth with root caries was 33.7% (28.7, 39.0), the prevalence of xerostomia was 23.1% (18.4, 28.3). Marked gradients in prevalence risk ratio were seen across different categories of Locker's global oral health item and the interRAI assessment tooth for coronal caries and xerostomia. Locker's global oral health item gave a better fitting model and was more discriminative in detecting coronal caries than the interRAI assessment tool (Lockers AIC = 0.76, interRAI AIC = 0.81). None of the approaches was particularly discriminative for root surface caries experience. Self-reported approaches are discriminative for poor oral health. Standardised assessment tools used in residential care facilities should consider including a self-assessment component such as Locker's global oral health item.

7 Designing and testing an integrated community care model with a remote home monitoring-alert device: a pilot study in Japan

Abstract Background An integrated model of health and social care in the community has been considered to be the gold standard, although many obstacles and challenges still exist. Living at one’s private home for as long as one wishes requires highly personalised arrangements, and therefore is costly, but assistive technologies can potentially facilitate this. In order to test the concept, a remote monitoring and care delivery system was developed. The usability and efficacy of the model were examined. Methods Sensor devices (biometric, temperature sensor and infrared camera sensor) were set up in the homes of five older people (aged 70 years and over), and the information was sent online to each older person, plus his/her family and caregivers. Using these devices, fifteen care professionals delivered home care and remotely supported the home life of the older adults between December 2022 and January 2023. A pre-post study design was adopted, collecting the System Usability Score (SUS), the International Classification of Functioning, Disability and Health (ICF) and the InterRAI assessments. The participating older adults and family members all consented to the research, which involved being observed or watched (all images are silhouettes only) when the system was in operation. Results Remote monitoring with alerts and two-way communication functions was highly valued by caregivers, as it provided an alternative model of care delivery, particularly for those living alone. While the device usability was not highly rated (D), several improvements in ICF and InterRAI scores were recorded (e.g. interpersonal communication, self-care, depressive tendencies). Conclusion While more research is necessary to increase the sample size and the duration of the data collection period, there is great potential for this model, embedding the use of assistive technologies into home care delivery. The study was funded in part by the Japan Agency for Medical Research and Development (22he2002023j0002).

Impact of family involvement and an advance directive to not hospitalize on hospital transfers of residents in long-term care facilities

ObjectiveWith the rapidly aging population, the number of residents transferred to hospitals from long-term care facilities (LTCFs) is increasing globally. The objective of this study was to investigate the association between family involvement and an advance directive (AD) for not hospitalizing and hospital transfers among LTCF residents with dementia. MethodUsing the InterRAI assessment database from September 2014 to June 2019, we included 874 residents from 16 LTCFs in Japan. ResultsOf the 874 participants, 19.0% had an AD for not hospitalizing, and 20.5% were transferred to hospitals. An AD for not hospitalizing decreased the likelihood of hospital transfers (p = 0.005). Multilevel logistic regression analysis showed that family involvement was not associated with hospital transfers (odds ratio [OR]: 1.18; 95% confidence interval [CI]: 0.77–1.80), while an AD for not hospitalizing was significantly associated with decreased hospital transfers (OR: 0.50; 95% CI: 0.28–0.89) among the LTCF residents. ConclusionsAlthough ADs are not legally defined in Japan, we found that an AD for not hospitalizing decreased hospital transfers. Given that many older people tend to hesitate to express their wishes in clinical decision-making situations in Japan, regular discussions are necessary to help them express their care preferences while also documenting the discussions to ensure the residents receive high-quality care.

Chronic health conditions and mortality among older adults with complex care needs in Aotearoa New Zealand

BackgroundOlder people have more comorbidities than younger groups and multimorbidity will increase. Often chronic conditions affect quality of life, functional ability and social participation. Our study aim was to quantify the prevalence of chronic conditions over a three-year period and their association with mortality after accounting for demographics.MethodsWe conducted a retrospective cohort study using routinely collected health data including community-dwelling older adults in New Zealand who had an interRAI Home Care assessment between 1 January 2017 and 31 December 2017. Descriptive statistics and differences between variables of interest among ethnic groups were reported. Cumulative density plots of mortality were developed. Logistic regression models adjusted for age and sex to estimate mortality were created independently for each combination of ethnicity and disease diagnosis.ResultsThe study cohort consisted of 31,704 people with a mean (SD) age of 82.3 years (8.0), and of whom 18,997 (59.9%) were female. Participants were followed for a median 1.1 (range 0 to 3) years. By the end of the follow-up period 15,678 (49.5%) people had died. Nearly 62% of Māori and Pacific older adults and 57% of other ethnicities had cognitive impairment. Diabetes the next most prevalent amongst Māori and Pacific peoples, and coronary heart disease amongst Non-Māori/Non-Pacific individuals. Of the 5,184 (16.3%) who had congestive heart failure (CHF), 3,450 (66.6%) died. This was the highest mortality rate of any of the diseases. There was a decrease in mortality rate with age for both sexes and all ethnicities for those with cancer.ConclusionsCognitive impairment was the most common condition in community dwelling older adults who had an interRAI assessment. Cardiovascular disease (CVD) has the highest mortality risk for all ethnic groups, and in non-Māori/non-Pacific group of advanced age, risk of mortality with cognitive impairment is as high as CVD risk. We observed an inverse for cancer mortality risk with age. Important differences between ethnic groups are reported.

Implementing the interRAI Check-Up Comprehensive Assessment: Facilitating Care Planning and Care Coordination during the Pandemic.

Long-stay home care patients are a large population of older adults with multi-morbidity and frailty. The COVID-19 pandemic posed challenges to executing care coordination and completing in-home assessments due to provincial mandates restricting in-person care. We evaluated the implementation of the interRAI Check-Up Self-Report instrument administered by phone and video. We report on a mixed-methods study, which involved the collection and analysis of survey and focus group data. Care coordinators from two regions in Ontario who had implemented the Check-Up at least once between March 2020 to September 2021 were recruited via convenience sampling. A total of 48 survey respondents and 7 focus group participants consented to the study. Advantages of completing the Check-Up over the telephone or video call included: reduced travel time, reduced risk of disease transmission, familiarity with the assessment questions, and reduced time spent administering the assessment. Limitations most frequently reported were: the inability to see the living environment, hearing impairments, inability to observe non-verbal responses or cues, language barriers, difficulty building rapport, and difficulty understanding the patient. The Check-Up was advantageous in providing sufficient information to create a care plan when administered over the phone and by video. Implementation of the Check-Up assessment was facilitated by familiarity and alignment with other interRAI assessments. Our results indicate that population characteristics need to be taken into consideration for administration of self-report style of assessments.

Older adults with schizophrenia and dementia: Analysis of a national dataset.

Individuals with schizophrenia develop dementia in late life at higher rates than the general population. This is arguably explained by high rates of chronic medical conditions and exposure to antipsychotic medications. This risk has implications for public health. We aimed to test this in a large New Zealand database. Participants in this study were New Zealanders aged 65 years or older who had an interRAI assessment completed during the study period (July 2013-June 2020). This cohort study analysed data from 168,780 individuals. The majority were European (87%), and mostly assessment was for home care (86%). There were 2103 individuals with schizophrenia, 1.25% of the total sample, mean age of 75 years (±1.9) and 61% female. A minority of individuals with schizophrenia, 23%, also had a dementia diagnosis. At 82 years of age (±1.7) and 60% female, 25% of individuals without schizophrenia had a dementia diagnosis; the difference from rate of dementia in individuals with schizophrenia was not statistically significant. These findings suggest that further study is needed about the processes that lead to dementia diagnoses in older individuals with schizophrenia.

Prevalence of sensory impairments in home care and long-term care using interRAI data from across Canada.

In the general population, sensory impairments increase markedly with age in adults over 60years of age. We estimated the prevalence of hearing loss only (HL), vision loss only (VL), and a combined impairment (i.e., dual sensory loss or DSL) in Canadians receiving home care (HC) or long-term care (LTC). Annual cross-sectional analyses were conducted using data collected with one of two interRAI assessments, one used for the HC setting (n = 2,667,199), and one for LTC (n = 1,538,691). Items in the assessments were used to measure three mutually exclusive outcomes: prevalence of VL only, HL only, or DSL. Trends over time for each outcome were examined using the Cochran-Armitage trend test. A negative binomial model was used to quantify the trends over time for each outcome while adjusting for age, sex and province. In HC, there was a significant trend in the rate for all three outcomes (p < 0.001), with a small increase (roughly 1%) each year. In HC, HL was the most prevalent sensory loss, with a rate of roughly 25% to 29%, while in LTC, DSL was the most prevalent impairment, at roughly 25% across multiple years of data. In both settings, roughly 60% of the sample was female. Males in both HC and LTC had a higher prevalence of HL compared to females, but the differences were very small (no more than 2% in any given year). The prevalence of HL differed by province after adjusting for year, age and sex. Compared to Ontario, Yukon Territory had a 26% higher rate of HL in HC (relative rate [RR] = 1.26; 95% confidence interval [CI]:1.11, 1.43), but LTC residents in Newfoundland and Labrador had a significantly lower rate of HL (RR: 0.57; CI: 0.43, 0.76).When combined, approximately 60% of LTC residents, or HC clients, had at least one sensory impairment. Sensory impairments are highly prevalent in both HC and LTC, with small sex-related differences and some variation across Canadian provinces. The interRAI assessments provide clinicians with valuable information to inform care planning and can also be used to estimate the prevalence of these impairments in specific population sub-groups.

A cross-sectional description of the health characteristics of cognitively impaired older adults.

The analysis presented here describes the care needs of older adults with and without cognitive impairment. To describe the health characteristics of older adults with and without cognitive impairment who receive home care or Aged Residential Care services in New Zealand. A descriptive analysis of the initial interRAI assessment for adults older than 55 years was undertaken. Data were grouped by level of assessed cognitive impairment. The population proportions for each level of the following scales were calculated: Changes in Health, End-stage Disease, Signs, and Symptoms Scale (CHESS), pain, pressure injury risk, Activities of Daily Living (ADL), depression screening, and body mass index (BMI). The analysis included 93,680 assessments. The mean age was 83 years (SD=8.7) a positive association was observed between age and cognitive impairment (p < 0.01). People with cognitive impairment were less likely to have been recently hospitalised or to have attended ED (p < 0.01). Significant associations with effect sizes ≥3 were observed for cognitive impairment and ADL (p < 0.01, γ=0.63), pain (p < 0.01, γ=-0.32), and risk of pressure injury (p < 0.01, Cramer's V=0.271). The results reinforce a need to be alert to the differential care needs of older adults with moderate/severe cognitive impairment. The findings may act as a trigger for practitioners to focus assessment on aspects of care that, due to context, may otherwise be underassessed or untreated.

Analysing Realistic effects of modifiable risk factors for dementia in a large National Dataset

BackgroundModifiable risk factors affect 40% of dementia risk thus creating an opportunity for prevention or delay. The risk factor life-course model of dementia prevention by the Lancet Commission has yet to be tested in the general populations. We aimed to assess the model's assumptions in a large national dataset of older adults assessed for support services. MethodsThe interRAI assessment is a comprehensive evidence-based tool encompassing 236 items that is mandatory in New Zealand (NZ) for older adults providing a standardized national dataset. We tested the Lancet model of dementia prevention in a sample of 66,638 participants who underwent an interRAI assessment during the period 2013-2018. There were 59% female interviewees; mean age was 82 years (range: 65-107). Our cross-sectional dataset analysis was performed in using a logistic regression model with diagnosis of dementia as the primary outcome. ResultsThe Lancet prevention model was supported in part. Hypertension, Hearing Impairment and past or present Depression increase risk of dementia. Age - increased risk demonstrated until 85 years; Gender – females at increased risk; BMI – initial effect of high BMI increases risk of dementia. However, exercise, diabetes, vision impairment and smoking as modifiable factors were not associated with dementia risk as predicted by the Lancet model. ConclusionsLimitations of the dataset analysed may have affected our findings. Nevertheless, important modifiable factors are herein confirmed as increasing dementia risk. BMI, hypertension, hearing impairment and depression are risks confirmed in the older NZ population lending credibility to prevention efforts targeted at these variables.